Growth Hormone Replacement Pregnancy: Use only if clearly needed — GH requirements change significantly in pregnancy (placental GH takes over); stop in late pregnancy. Seek specialist endocrinology advice.

Somatropin (Recombinant Human Growth Hormone)

Brand names: Genotropin, Humatrope, Norditropin, Saizen, Omnitrope

Adult dose

Dose: Adult GH deficiency: starting dose 0.15–0.3mg SC OD (elderly or IGF-1 near upper limit: start 0.1mg OD); titrate every 1–2 months based on IGF-1 (target: age- and sex-normalised IGF-1). Usual maintenance 0.3–1mg OD. Short bowel syndrome: 0.1mg/kg OD for 4 weeks (specialist use).

Route: Subcutaneous injection

Frequency: Once daily (evening — mimics physiological nocturnal GH secretion)

Max: 1mg OD (most adults); higher doses in specialist rare-disease indications

NICE TA64: somatropin for adult GH deficiency only if severe (peak GH <9 mU/L on stimulation test) AND quality of life significantly impaired. Titrate to achieve IGF-1 in the upper half of the age-normalised reference range. Administer at bedtime to mimic physiological pulsatile GH secretion.

Paediatric dose

Dose: 0.025 mg/kg

Route: Subcutaneous injection

Frequency: Once daily at bedtime

Max: 0.05mg/kg OD (Turner syndrome, Prader-Willi, SGA); 0.035mg/kg OD (GH deficiency)

BNFc: GH deficiency: 0.025–0.035mg/kg OD SC at bedtime. Turner syndrome: 0.045–0.05mg/kg OD. Prader-Willi: 0.035mg/kg OD. SGA (short for gestational age, no catch-up growth): 0.035mg/kg OD. All paediatric use under specialist paediatric endocrinology supervision.

Dose adjustments

Renal

CKD patients with GH deficiency: specialist guidance required — retained urinary GH metabolites; use lower starting doses.

Hepatic

No specific adjustment — monitor IGF-1 closely.

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

NICE TA64: adult GH deficiency — only prescribe if quality of life score (QoL-AGHDA) ≥11 AND peak GH <9 mU/L on stimulation test; reassess response at 9 months and continue only if QoL improves by ≥7 points
Evening injection is important — GH secretion peaks during slow-wave sleep; mimicking this pattern optimises IGF-1 response
Malignancy history: somatropin contraindicated in active malignancy but can be prescribed to cancer survivors (≥1 year remission) — risk of recurrence not significantly increased per current data
Paediatric: Prader-Willi syndrome — sleep study mandatory before starting due to risk of sudden death from sleep apnoea exacerbation

Contraindications

Active malignancy (completed treatment required before starting)
Acute critical illness (trauma, post-cardiac surgery — increased mortality in ICU studies)
Closed epiphyses AND height gain not the goal (adults — not a contraindication but height gain no longer possible)
Diabetic retinopathy (active proliferative)
Prader-Willi syndrome with severe obesity or respiratory impairment (sudden death risk — screen for sleep apnoea)

Side effects

Fluid retention / peripheral oedema (especially at initiation)
Arthralgia and myalgia
Carpal tunnel syndrome
Headache / intracranial hypertension (rare — monitor fundoscopy)
Glucose intolerance / insulin resistance (monitor HbA1c)
Progression of scoliosis (paediatric use)
Lipoatrophy at injection site

Interactions

Glucocorticoids — antagonise GH effects; patients on prednisolone require dose monitoring
Insulin, antidiabetic drugs — GH increases insulin resistance; adjust doses
Cyclosporin — GH may increase cyclosporin levels

Monitoring

IGF-1 (every 1–2 months during titration, then 6 monthly)
HbA1c / fasting glucose
Fundoscopy (children — intracranial hypertension)
Thyroid function (GH can unmask central hypothyroidism)
Height and bone age (children)
Bone density (adults)

Reference: BNFc; BNF 90; NICE TA64 (Somatropin for Adult GH Deficiency); NICE TA188 (Paediatric GH Deficiency). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways